MORE FOLIC-ACID FOR EVERYONE, NOW

Research during the last 5 years has made it clear that people who do not take folic acid: supplements are at increased risk for functional folate deficiency, which has been proven to cause spina bifida and ane ncephaly and also has been associated with an increased risk for occlu sive cardiovascular disease. The overriding folate policy issue is how to increase dramatically the folate consumption of 75% of the populat ion who are not now consuming 0.4 mg of folic acid in a supplement. Th e most expeditious way to increase consumption is through fortificatio n of a food staple. Public health programs are also needed to educate people about the vital importance of increased consumption of folic ac id vitamin supplements and of foods rich in natural folates. It is urg ent that fortification of cereal-grain products be implemented now. Th e level proposed by FDA would accomplish some prevention, but much mor e prevention would occur if the fortification were 2.5 times that leve l. Fortification at the higher level would prevent about 1000 spina bi fida and anencephaly birth defects each year and perhaps as many as 50 ,000 premature deaths each year from coronary disease. Available data have not demonstrated that increasing consumption of folic acid by 0.1 to 0.25 mg of folic acid a day is harmful. If a policy needs to be es tablished on the assumption that people who take vitamin supplements c ould be harmed, a good policy option is available: require that all fo lic acid vitamin supplements also contain 0.4 mg of vitamin B-12.